Cancer can be successfully treated by surgical excision alone
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While certain early-stage or localized cancers can be successfully managed with surgical excision alone, many cancers require multidisciplinary approaches combining surgery with radiation or chemotherapy.
BACKGROUND AND OBJECTIVES: The recipients of liver transplantation (LT) are subjected to lifelong immunosuppression with its many drawbacks. De novo and recurrent malignancy in transplant recipients are attributed to attenuation of immunosurveillance. In the present study, we present our experience with de novo malignancies encountered after both deceased and living donor liver transplantations. DESIGN AND SETTING: Retrospective study of patients referred to LT center between April 2001 and January 2010 PATIENTS AND METHODS: Various data were collected including type of malignancy and histopathologic features, immunosuppression regimen, and patient survival. RESULTS: Of 248 LT procedures performed in 238 patients (10 retransplants), 8 patients (3.4%) developed de novo post-LT malignancies. De novo malignancies included post-LT lymphoproliferative disorders (PTLD) in 5 patients who were all Epstein-Barr virus (EBV) positive, and who were treated successfully with anti-CD20 monoclonal antibody therapy, reduction of immunosuppression, and control of EBV activity; urinary bladder cancer in 1 patient who was treated with radical surgical resection and chemotherapy but died of bone and lung metastasis within 1 year of diagnosis; endometrial carcinoma in 1 patient who was treated with radical surgical resection; and Kaposi sarcoma in 1 patient who was successfully treated with surgical excision and reduction of immunosuppression. CONCLUSION: EBV-associated PTLD is the most frequentl
Splenic metastasis is known to occur at the terminal stage of cancer. While peritoneal dissemination is the most frequent recurrence of gastric cancer, metastasis to the spleen from gastric cancer is very rare. Splenectomy is currently the most effective probable treatment for solitary splenic metastasis of gastric cancer; it provides a good patient prognosis. However, careful consideration of surgical indications is required, as splenic metastasis is typically accompanied by multi-organ metastasis and dissemination. One of the main cancer treatment methods is the “wait-and-see” approach using chemotherapy. In general, patients with gastric cancer are treated with systemic chemotherapy for distant metastases including peritoneal dissemination. Radiotherapy is not commonly used to prolong life in patients with gastric cancer as gastric cancer is predominantly adenocarcinoma. However, a recent report indicated that chemo-radiotherapy was performed successfully for unresectable gastric cancer, including peritoneal dissemination. Here, we present the case of a 67-year-old patient who was observed to have peritoneal dissemination and splenic metastasis after gastric cancer surgery. Once the peritoneal dissemination was localized, surgical excision and chemo-radiotherapy were performed. We treated the splenic metastasis with the “wait-and-see” strategy with chemotherapy. A complete response on imaging in accordance with the Response Evaluation Criteria in Solid Tumors was achieved
Background Defects of the cheek present a reconstructive challenge because of the visibility of the site, as well as the limited local tissue supply. In addition, the cheek abuts several structures with expressive function, such as the eye, mouth, and surrounding facial musculature. This report describes a system of classifying cheek defects according to tumor size and location and present corresponding reconstruction techniques used to accomplish three-dimensional restoration of all missing components and adequate texture matching. Methods From 2008 to 2013, 27 patients with cheek defects resulting from skin cancer excision were treated. According to the size of the defect, location on the cheek, and relationships to adjacent structures and existing skin tension lines, different surgical methods were applied. Results The procedures used for cheek reconstruction included direct closure, Limberg flap, V-Y advancement flap, slide-swing flap, cheek rotation flap, and full-thickness skin graft. All flaps healed well without major complications, and no cancer recurrence was detected during follow-up. Conclusions The anatomic classification of skin cancers and surgical protocols described in this report is simple and appropriate for reconstruction involving the cheek. Wide excision of skin cancer and appropriate, relatively easy-to-perform flaps based on this classification system can successfully produce safe and aesthetically-pleasing surgical outcomes.
Introduction: Ruxolitinib, a Janus kinase (JAK) 1/2 inhibitor approved for the treatment of myelofibrosis and polycythemia vera, has been associated with an increased risk of non-melanoma skin cancer. While squamous cell carcinoma (SCC), basal cell carcinoma, and keratoacanthomas are commonly reported, Bowen’s disease (BD), the in situ form of SCC, has been only rarely described. Case Presentation: We report the case of a 53-year-old woman with polycythemia vera, treated with ruxolitinib for over 9 years. Six months after a dose escalation, she developed multiple erythematous, hyperkeratotic plaques on the trunk and limbs. Histopathological examination confirmed the diagnosis of BD. Over the years, she continued to develop new lesions approximately once per year. All lesions were managed successfully with cryotherapy or surgical excision, and no invasive SCC was observed. She has been under close dermatologic surveillance with full-body skin examinations every 6 months. Conclusion: This is the first fully documented case of eruptive, multiple BD associated with long-term ruxolitinib therapy. The distinctive chronic pattern, histologically confirmed and followed prospectively for nearly a decade, highlights a potentially underrecognized cutaneous adverse effect of JAK inhibition, warranting further research and awareness among prescribing clinicians.
defini¬ tive surgical treatment can be performed without open biopsy. Surgical excision of … that preclude surgical resection. Furthermore, the surgical margins that can be obtained around … best treated by radiotherapy. Lesions larger than 2 cm should be treated by surgical excision
Abstract Background The aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum. Methods Seventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months). Results At the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy. Conclusions Our results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrot
Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of multiple, non-syndromic metastatic BCC with an uncommon primary site in the chest and pulmonary metastases, treated successfully with surgery and vismodegib. A 51-year-old woman presented with a large pigmentary lesion of the chest, close to the sternum. She had the lesion for > 25 years and lately noticed multiple facial lesions. The diagnosis of multiple BCC was suspected and a punch biopsy of the primary lesion was performed. Diagnosis was confirmed by immunohistochemistry (BerEp4+, EMA− phenotype). After excision, staging with a thorax computed tomography scan revealed metastatic micro-nodules in the left lung, confirmed histologically after video-assisted thoracic surgical biopsy. Adjuvant chemotherapy with vismodegib was proposed and administered. At 30 days follow-up, thorax computed tomography scan was unaltered and her facial lesions showed significant regression. Although prognosis remains poor, early diagnosis and prompt management complimented by novel biological agents, like vismodegib, targeting disease pathogenesis, seems to bring promising results.
Background and purpose: Organ preservation after total neoadjuvant therapy (TNT) is feasible in patients with locally advanced rectal cancer (LARC) who achieve a clinical complete response (cCR). However, most watch-and-wait (WW) evidence derives from long-course chemoradiotherapy (LCCRT), with limited data regarding short-course radiotherapy (SCRT)-based TNT. We evaluated response-adapted organ preservation following SCRT-based TNT in a public, resource-limited healthcare setting. Materials and methods: This retrospective cohort included consecutive patients with stage II–III LARC (cT3-T4 and/or N+) with palpable tumors ≤8 cm from the anal verge treated between 2020 and 2023. All patients received SCRT (25 Gy in five fractions) followed by consolidation chemotherapy (FOLFOX or CAPOX). Tumor response was assessed 8–12 weeks after TNT using digital rectal examination, pelvic MRI, flexible sigmoidoscopy and CEA levels. Patients achieving a cCR were managed with a structured WW protocol; others underwent total mesorectal excision (TME). Time-to-event outcomes were estimated descriptively. Results: Among 51 evaluable patients, 19 (37.3%) achieved cCR and 18 (35.3%) were managed with WW. After a median follow-up of 43.2 months (IQR 34.1–51.5), 3 WW patients (16.7%) developed local regrowth, all successfully salvaged with R0 resection. The estimated 24-month local regrowth-free survival was 82.2% (95% CI 65.8–100%). One WW patient died from systemic progression after salvage surger
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